US 20070174087 A1
A system and method for managing form-generated data related to a patient encounter involves translating location information related to a user writing on a form into a contextualized data element that includes contextual information. The contextual information helps to explain and/or give meaning to the user writing. Contextual information may include a descriptive name, an identification of data type, healthcare classification information, taxonomic information, an indication of the patient, an indication of the person that wrote on the form, and/or an indication of the date and time at which the writing occurred. The contextual information is then used by an Electronic Medical Record (EMR)/Electronic Health Record (EHR) application to perform a function such as patient/insurance billing, case management, or order fulfillment.
1. A system for managing form-generated data related to a patient encounter, the system comprising:
a form having designated information fields at different locations on the form;
an electronic writing system configured to generate location information that identifies the location of a user writing on the form;
a contextualizer configured to translate location information related to the user writing to a contextualized data element, wherein the contextualized data element comprises contextual information that is associated with the user writing; and
an application that utilizes the contextual information in the contextualized data element to perform a function that is related to the user writing on the form.
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19. A method for managing form-generated data related to a patient encounter, the method comprising:
receiving location information related to a form that has designated information fields in different locations on the form, wherein the location information is generated in response to a user writing on the form in one of the designated information fields;
translating the location information to a contextualized data element, wherein the contextualized data element comprises contextual information that is associated with the user writing; and
utilizing the contextual information in the contextualized data element to perform a function related to the user writing on the form.
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an indication of the patient associated with the patient encounter;
an indication of the substance of the patient encounter; and
an indication of the time of the patient encounter.
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33. Processor-accessible storage media comprising processor-executable instructions, that when executed, direct a computer system to perform the method as recited in
This application is entitled to the benefit of provisional U.S. Patent Application Ser. No. 60/758,842, filed Jan. 13, 2006 and provisional U.S. Patent Application Ser. No. 60/810,248, filed Jun. 2, 2006, the disclosures of which is incorporated by reference herein in its entirety.
The invention relates generally to managing form-generated data, and in particular, to managing form-generated data that is related to a patient encounter and used by one or more electronic medical record (EMR) and/or electronic health record (EHR) applications to perform a function such as patient/insurance billing, case management, and/or order fulfillment.
Typical EMR/EHR software applications produced for use by front-line healthcare workers follow a flow-based model. That is, the healthcare provider is required to navigate through a series of windows according to a pre-established flow and then enter data related to a patient encounter at the appropriate window. Because the data is entered at a window that is part of a pre-established flow, the EMR/EHR application knows exactly what type of data to expect at each data entry point. For example, if a healthcare worker navigates to a diagnosis window and checks a box labeled “sprained ankle,” the EMR/EHR application is coded to identify the input data as a sprained ankle. A drawback to applying flow-based software applications to the healthcare industry is that the flow produced by the software developer and coded into the application may not match the actual work flow of a healthcare worker.
Electronic writing systems have been developed to translate a user writing on a paper form to electronic data. Translating user writing on a paper form to electronic data can help free a healthcare worker from the requirements of rigid flow-based EMR/EHR applications. Typical electronic writing systems track the pen strokes of a user writing on a form and generate a data set that represents the user's pen strokes. The pen stroke data set is then used to create an electronic image of the marked up form. The electronic image can be viewed on a remote computer to perform various tasks that need to be completed subsequent to a patient encounter (e.g., patient/insurance billing, case management, order fulfillment, etc.).
While creating an electronic image of a marked up form on a remote computer allows subsequent electronic access to the marked up forms, to glean useful data from the user writing on the form, a person viewing the electronic image must manually convert the user writings to useable data, by for example, keying in data from check boxes. Alternatively, useful data can be gleaned from the pen stroke data set by programming the EMR/EHR application to relate pen stroke data directly to a software routine or action. For example, a software developer must hardcode that a check at the coordinates of a box labeled “sprained ankle” translates to the diagnosis of a sprained ankle. This process is very inefficient for a software developer because it requires the developer to have specific knowledge of the layout of every information field on every form that is to be used with the EMR/EHR application. Further, even if the developer does attempt to hardcode every field of every form to a corresponding routine or action, it is often desirable or necessary to change the layout of a form to accommodate new and/or different information. If an EMR/EHR application is directly dependent on the layout of a form, the EMR/EHR application must be reprogrammed to reflect each subsequent layout change.
Further, different electronic writing systems exist which use different techniques to translate user writings to a pen stroke data set. Consequently, the same information on a form may result in a different pen stroke data set depending on which electronic writing system is used to track the pen strokes and therefore an EMR/EHR application must be coded to deal with all the possible pen stroke data sets for each electronic writing system that is to be supported by the EMR/EHR application.
A system and method for managing form-generated data related to a patient encounter involves translating location information related to a user writing on a form into a contextualized data element that includes contextual information. The contextual information helps to explain and/or give meaning to the user writing. For example, contextual information may include a descriptive name, an identification of data type, healthcare classification information, taxonomic information, an indication of the patient, an indication of the person that wrote on the form, and/or an indication of the date and time at which the writing occurred. The contextual information is then used by an EMR/EHR application to perform a function such as patient/insurance billing, case management, order fulfillment, etc.
By translating location information related to a user writing into a contextualized data element, EMR/EHR applications are insulated from the specific layout of paper forms that are used by healthcare workers, thereby allowing EMR/EHR applications to be developed independent of the actual layout of the forms. Additionally, the translation of location information to contextualized data elements insulates EMR/EHR applications from the specifics of the electronic writing system so that the EMR/EHR applications can be developed independent of the type of electronic writing system that is used.
Other aspects and advantages of the present invention will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, illustrating by way of example the principles of the invention.
Throughout the description, similar reference numbers may be used to identify similar elements.
Various different types of electronic writing systems can be used to generate location information related to a user writing on a surface such as a piece of paper or a form. Exemplary electronic writing systems include:
1) a camera-based pen system that works in conjunction with special encoding on a piece of paper. In general, these camera-based pen systems include a pen with an optical sensor (camera) in the end and a paper that has a position-coding pattern which is detectable by the optical sensor. The absolute position of the pen on the paper is determined by monitoring the position-coding pattern through the optical sensor as the pen is used to write on the paper. Various aspects of camera-based pen systems are described, for example, in U.S. Pat. Nos. 6,548,768, 6,570,104, 6,663,008, 6,667,695, 6,674,427, and 6,899,966;
2) a radio frequency (RF) or infrared (IR) detection system that uses triangulation to track the movement of a pen around the x-y plane of a piece of paper. In one embodiment, the detection system is clipped onto a piece of paper and RF or IR based triangulation is used to track the movement of a pen as a user writes on the paper. The tracked movement is then recorded in the detection system for subsequent transfer to a more powerful computer system; and
3) a tablet computer system that displays a form on a computer screen and detects contact with the screen by a stylus to track the movement of the stylus as a user writes on the screen.
The contextualizer 104 converts location information (e.g., a pen stroke data set) from the electronic writing system into at least one contextualized data element 116 that can be used by the EMR/EHR application 106 to perform a function such as patient/insurance billing, case management, order fulfillment, and/or clinical studies, etc. In an embodiment, a contextualized data element includes root information and contextual information. The root information is the information that is intended to be conveyed through the user writing. The root information may include, for example, pen stroke coordinates if the information to be conveyed is an image of the user writings and/or alphanumeric information if the information to be conveyed is simply a numeric code or a word. The contextual information is information that provides context to the root information. For example, contextual information is information that explains and/or gives meaning to the root information. As is described in more detail below, the contextual information may include a region label, an area label, an indication of the root data type, temporal information, an indication of the patient to which the root information is associated, and/or an indication of the user that made the writings on the form. The writing on a form can be translated to one or more contextualized data elements. Multiple contextualized data elements can be combined into an encounter data set, which characterizes a patient encounter.
The contextualized data elements are used by the EMR/EHR application to perform a function. The EMR/EHR application performs functions based on data collected via the electronic writing system 102. Exemplary functions performed by the EMR/EHR application include, but are not limited to, patient/insurance billing, case management, and order fulfillment.
In accordance with the invention, the EMR/EHR application uses at least one contextualized data element to perform a function. Although only one EMR/EHR application is depicted in
The process of translating location information related to a user writing to a contextualized data element is now described with reference to
In order to translate location information into contextualized data elements, the designated information fields on the form of
In an embodiment, the labels associated with the designated information fields include an element or elements that correspond to standardized medical terms and/or codes and/or accepted terminology and/or codes used in EMR/EHR applications. For example, labels may incorporate: International Classification of Diseases (ICD) codes, for example, ICD version 9 (ICD-9) codes and Current Procedure Terminology (CPT) codes, both of which are published by the American Medical Association (AMA). An exemplary label could incorporate the code “845.00,” which is the ICD-9 code for a sprained ankle. The labels may have a structure that corresponds to accepted medical classifications.
The label of a designated information field may also identify the type of root information that is to be gleaned from a user writing in the designated information field. For example, the root information gleaned from a user writing in the designated information field may be:
1) pen stroke information that can be used to create an electronic image of the user writing on the form;
2) alphanumeric information, for example, a name or number that corresponds to a checked box or alphanumeric information that is recovered via character recognition; and
3) pin pad information, for example, the numbers 0-9, a decimal point, and a cancel pin, which can be used to enter specific numerical values.
In another embodiment, the label of a designated information field may represent a rule or function that is to be carried out. For example, the label of a designated information field my trigger a function such as indicating that the writing on a form is to be forwarded to an application (e.g., a “finalize” function).
In the embodiment of
In conjunction with labeling the designated information fields as described above with reference to
In an embodiment, a location translation is generated through a graphical user interface that first provides an image of the form. A user then identifies a designated information field against the background of the form. In particular, the user sets the size and location of the designated information field relative to the form and the corresponding coordinates of the designated information field, which will be used for location translation, are calculated. Once the size and location of the designated information field is identified, the designated information field is assigned a label.
If the physical location of a designated information field changes on a form, the location translation for the designated information field can be changed to reflect the new location. In particular, a change in the location of a designated information field is accommodated simply by changing the defined user area of a location translation. That is, no change in the label is required to accommodate a change in the location of a designated information field. For example, referring to
Once the designated information fields of a form have been labeled and a mapping data set established, the contextualizer 104 can translate location information related to user writings into contextualized data elements.
In operation, user writings 132 on the form of
Contextualized data elements 162-176 have basically the same structure as contextualized data element 160. Although each subsequent contextualized data element does not repeat the region label, the region label is assumed to be the same for all subsequent contextualized data elements until a new region label is identified. In an alternative embodiment, common contextual information can be repeated for each contextualized data element.
Some user writings 132 can be translated into more than one contextualized data element. For example, the user writings in the designated information fields labeled “chart*diagnosis*1” and “chart*diagnosis*2” are represented in the “diagnosis—1” and “diagnosis—2” contextualized data elements 168 and 170, respectively, and the user writing in both fields is represented in the more general “diagnosis” contextualized data element 166.
A contextualized data element can include various types of contextual information. For example, contextual information may include an indication of the patient to which the root information belongs, an indication of the healthcare worker that made the user writings on the form, an indication of the instrument that was used to make the user writings (e.g., a pen ID), an indication of the date of the user writings, a transaction identifier and/or insurance information. Further, certain contextual information can be associated with multiple contextualized data elements in an encounter data set. Referring again to
As described above, the root information 182 is not always pen stroke data that is used to create an image of the user writings on the form. In an embodiment, the root information is alphanumeric data that is gleaned from the pen stroke data. For example, the root information is a numeric code that represents a particular diagnosis or treatment that is gleaned from a checked box on a form. Referring to
In accordance with an embodiment of the invention, an EMR/EHR application utilizes contextual information in the contextualized data elements to perform a function that is related to the user writing on a form. How the contextual information is utilized to perform a function is entirely dependent on the function that is to be performed. In one embodiment, the contextual information is used by the EMR/EHR application to identify the contextualized data element. For example, the contextualized data element related to the “Chief Complaint” designated information field is called by an EMR/EHR application using the label “chief_complaint” instead of by identifying the corresponding coordinate set that identifies the user area boundaries. In another embodiment, the contextual information is used by the application to identify the patient associated with the contextualized data element, the writing instrument that was used, the type of root data that is included in the contextualized data element, and/or the date and time of the user writing.
In an embodiment, the contextualizer is part of a middleware application that helps to distribute contextualized data elements to EMR/EHR applications. In an embodiment, the middleware and EMR/EHR applications exchange information according to a publish/subscribe protocol. In particular, the EMR/EHR applications request certain form-generated information that is related to a patient encounter (i.e., subscribe) and the middleware application ensures that any information meeting the application's request is provided (i.e., published) to the application. Because contextualized data elements are provided in a publish/subscribe environment, there is no need to maintain a continuous connection between the middleware and the application once a subscription request is made.
Even though multiple contextualized data elements may be grouped together into a single encounter data set, the individual contextualized data elements can be parsed and treated separately for purposes of distribution to the EMR/EHR application. That is, EMR/EHR applications can subscribe to a subset of the contextualized data elements that make up an encounter data set. Additionally, different EMR/EHR applications may subscribe to different information and the contextual information associated with the contextualized data elements allows the contextualized data elements to be managed as distinct information elements.
In an environment that includes different EMR/EHR applications for different functions (e.g., three separate EMR/EHR applications for patient/insurance billing, case management, and order fulfillment), the middleware application distributes to the different EMR/EHR applications only those contextualized data elements that are requested by the applications.
Because the location information that identifies the location of user writings on a form has been translated to contextualized data elements, the EMR/EHR applications can be configured to operate based on contextual information instead of raw location information such as coordinates. Because the EMR/EHR applications operate based on contextual information instead of raw location information, the EMR/EHR applications are effectively independent of the physical layout of a form. That is, if a designated information field is moved to a new physical location on a form, only the location translation related to the designated information field needs to be changed to reflect the new physical location of the designated information field. That is, the defined user area is changed to reflect the new location on the form while the label remains the same. The change in location requires no modification to the EMR/EHR application. This layout-independence allows EMR/EHR applications to be developed without concern for the physical layout of forms.
A method in accordance with the present invention may also be implemented, for example, by operating a computer system to execute a sequence of machine-readable instructions. The instructions may reside in various types of computer readable media. In this respect, another embodiment of the invention involves a programmed product, comprising computer readable media tangibly embodying a program of machine readable instructions executable by a digital data processor to perform a method for discarding routes from a router. This computer readable media may comprise, for example, RAM contained within the contextualizer. Alternatively, the instructions may be contained in another computer readable media such as a magnetic data storage diskette and directly or indirectly accessed by the contextualizer. Whether contained in the computer system or elsewhere, the instructions may be stored on a variety of machine readable storage media, such as a DASD storage (e.g. a conventional “hard drive” or a RAID array), magnetic tape, electronic read-only memory, an optical storage device (e.g., CD ROM, WORM, DVD, digital optical tape), paper “punch” cards, or other suitable computer readable media including transmission media such as digital, analog, and wireless communication links. In an illustrative embodiment of the invention, the machine-readable instructions may comprise lines of compiled C, C++, or similar language code commonly used by those skilled in the programming for this type of application arts.
Although the system and method for managing form-generated data is described with reference to a patient encounter, the system and method could be applied to other instances where forms are used to collect information that is later used by a software application to perform a function such as billing, order fulfillment, scheduling, etc.
Although specific embodiments of the invention have been described and illustrated, the invention is not to be limited to the specific forms or arrangements of parts as described and illustrated herein. The invention is limited only by the claims.